Referring Dentists

For successful orthodontic treatment, on-going communication between the general dentist and orthodontist is paramount.  We remind patients of this close relationship and encourage them to visit their dentist at least every six months.

To refer a patient for an orthodontic assessment, please complete the online Referral form below. We will contact your patient and arrange a convenient appointment and keep you informed of the patient’s treatment plan and progress.

Practice Details

  • Practitioner's name:*
  • Practice phone:*
  • Practice email:*

Patient Details

  • New patient?*
  • Patient's name:*
  • Patient's date of birth:* (dd/mm/yyyy)
  • Patient's email:
  • Patient's phone:*
  • Patient's address:*

Appointment Details

  • NHS or private?*
  • Purpose of appointment?*

Additional Details

  • Your comments:
  • Are you an existing Hampstead Orthodontic Practice referring dentist?*
  • Send a referral pad?*

* Required fields